The average age of onset for "natural" menopause is 51. However, because of genetics, illness, or medical procedures, some women go through menopause before the age of 40. Menopause that occurs before this age, whether natural or induced, is known as "premature" menopause.
In addition to dealing with hot flashes, mood swings, and other symptoms that accompany menopause, many women undergoing premature menopause have to cope with additional physical and emotional concerns. For example, because menopause signals the end of a woman's fertile years, a woman who wishes to get pregnant is likely to have trouble.
What Are the Symptoms of Premature Menopause?
Symptoms of premature menopause are often the same as those experienced by women undergoing natural menopause and may include:
. Irregular or missed periods
. Periods that are heavier or lighter than usual
. Hot flashes (a sudden feeling of warmth that spreads over the upper body)
These symptoms are a sign that the ovaries are producing less estrogen. Along with the above symptoms, some women may experience:
. Vaginal dryness (the vagina may also become thinner and less flexible)
. Bladder irritability and worsening of loss of bladder control (incontinence)
. Emotional changes (irritability, mood swings, mild depression)
. Dry skin, eyes, or mouth
. Decreased sex drive
In addition to the symptoms listed above, if you are under the age of 40 and experience any of the following conditions, you should see your doctor to determine whether you are undergoing premature menopause:
. You have undergone chemotherapy or radiation
. You or a family member has an autoimmune disorder such as hypothyroidism, Graves' disease, or lupus
. You have unsuccessfully tried to become pregnant for more than a year
. Your mother or sister experienced premature menopause
How Is Premature Menopause Diagnosed?
To diagnose premature menopause, your doctor will most likely perform a physical exam and draw blood to rule out other conditions, such as pregnancy and thyroid disease. They may also order a test to measure your estradiol levels. Low levels of estradiol, a form of estrogen, can indicate that your ovaries are starting to fail. When estradiol levels are below 30, it may signal that you are in menopause.
However, the most important test used to diagnose premature menopause is a blood test that measures follicle stimulating hormone (FSH). FSH causes your ovaries to produce estrogen. When your ovaries slow down their production of estrogen, your levels of FSH increase. When your FSH levels rise above 40 mIU/mL, it usually indicates that you are in menopause.
Are There Other Health Issues That Affect Women in Premature Menopause?
Like all menopausal women, women in premature menopause experience lowered estrogen levels as the ovaries stop most of their production of this hormone. Low levels of estrogen can lead to changes in women's overall health and may increase their risk for certain medical conditions, such as osteoporosis. Other health risks associated with the loss of estrogen include increased risk for colon and ovarian cancer, periodontal (gum) disease, tooth loss, and cataract formation.
However, compared with women who go through natural menopause, women undergoing premature menopause spend a greater portion of their lives without the protective benefits of their own estrogen. This puts them at an even greater risk for the above-mentioned menopause-related health problems.
How Is Premature Menopause Treated?
There is no treatment that can reverse or prevent premature menopause. However, women who have reached menopause do have treatment options that can help control unpleasant symptoms.
Types of treatments for symptom relief include:
. Hormone therapy: hormone therapy (HT, or estrogen therapy, ET) is available in different forms including pills, patches, transdermal sprays, or gels or creams. Localized hormone treatments are also available for intravaginal use. HT/ET is the most effective way to control symptoms like hot flashes and vaginal dryness. Because HT/ET has been associated with certain health risks (heart attack, stroke, and breast cancer), experts recommend using the lowest effective dose of hormone therapy for the shortest period of time necessary for symptom control.
. Oral contraceptive pills are a form of HT that is sometimes used to help relieve menopausal symptoms.
. Antidepressant medications: the selective serotonin reuptake inhibitors (SSRIs) and related medications have been shown to be effective in controlling the symptoms of hot flashes in up to 60% of women.
. Non-hormonal vaginal gels, creams, and lubricants can help prevent the symptoms of vaginal dryness.
. Assisted reproductive technologies: in selected cases, pregnancy may be achieved using donor eggs in women with premature menopause.
Can I Still Get Pregnant After Being Diagnosed with Premature Menopause, Early Menopause or Primary/Premature Ovarian Insufficiency?
Unless the ovaries have been surgically removed, it can be difficult to diagnose a woman younger than age 45 with “menopause” as opposed to primary ovarian insufficiency (POI). Women with POI can have intermittent ovulation, which may or may not be accompanied by a menstrual bleed. Other women may be able to get pregnant through in vitro fertilization with egg donation. It is important to work with a fertility specialist to explore options.
Options available to you will vary depending on whether you have interest in having children in the future. In some cases, fertility may be restored and pregnancy could be possible. Assisted reproductive technology (ART), including in vitro fertilization (IVF) might be considered. If you do not want to get pregnant while on hormone-replacement therapy, your doctor will talk to you about contraceptive options. Talk to your healthcare provider about possible causes of premature or early menopause and your questions regarding fertility.
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